ABSTRACT
We describe a case of Ewing sarcoma in the metacarpal of a 5-month-old male. After pain, erythema, and swelling of the hand failed to resolve with antibiotics, radiographs and magnetic resonance imaging raised suspicion for a neoplastic condition. Open biopsy confirmed the diagnosis of Ewing sarcoma and treatment with chemotherapy and surgical resection was initiated. Ewing sarcoma of the hand in a patient this young is an exceedingly rare diagnosis, which highlights the importance of a broad differential diagnosis when the treatments for more common conditions fail.
Subject(s)
Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Metacarpal Bones/pathology , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/therapy , Biopsy , Combined Modality Therapy , Diagnosis, Differential , Humans , Infant , Magnetic Resonance Imaging , MaleABSTRACT
Skeletal muscle injury and repair are complex processes, including well-coordinated steps of degeneration, inflammation, regeneration, and fibrosis. We have reviewed the recent literature including studies by our group that describe how to modulate the processes of skeletal muscle repair and regeneration. Antiinflammatory drugs that target cyclooxygenase-2 were found to hamper the skeletal muscle repair process. Muscle regeneration phase can be aided by growth factors, including insulin-like growth factor-1 and nerve growth factor, but these factors are typically short-lived, and thus more effective methods of delivery are needed. Skeletal muscle damage caused by traumatic injury or genetic diseases can benefit from cell therapy; however, the majority of transplanted muscle cells (myoblasts) are unable to survive the immune response and hypoxic conditions. Our group has isolated neonatal skeletal muscle derived stem cells (MDSCs) that appear to repair muscle tissue in a more effective manner than myoblasts, most likely due to their better resistance to oxidative stress. Enhancing antioxidant levels of MDSCs led to improved regenerative potential. It is becoming increasingly clear that stem cells tissue repair by direct differentiation and paracrine effects leading to neovascularization of injured site and chemoattraction of host cells. The factors invoked in paracrine action are still under investigation. Our group has found that angiotensin II receptor blocker (losartan) significantly reduces fibrotic tissue formation and improves repair of murine injured muscle. Based on these data, we have conducted a case study on two hamstring injury patients and found that losartan treatment was well tolerated and possibly improved recovery time. We believe this medication holds great promise to optimize muscle repair in humans.
Subject(s)
Muscle, Skeletal , Muscular Diseases/therapy , Regenerative Medicine/methods , Angiotensin II Type 1 Receptor Blockers/pharmacology , Animals , Disease Models, Animal , Humans , Losartan/pharmacology , Muscle, Skeletal/cytology , Muscle, Skeletal/injuries , Muscle, Skeletal/metabolism , Muscular Diseases/metabolism , Muscular Diseases/pathology , Neovascularization, Physiologic , Oxidative Stress , Paracrine Communication , Regeneration , Stem Cell Transplantation , Stem Cells/cytology , Stem Cells/physiology , Tendon Injuries/therapy , Treatment Outcome , Wound HealingSubject(s)
Arthrodesis/methods , Osteoarthritis/diagnosis , Osteoarthritis/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Arthrodesis/instrumentation , Bone Plates , Bone Screws , Bone Transplantation , Diagnosis, Differential , Diagnostic Imaging , Equipment Failure , Humans , Male , Middle Aged , Osteoarthritis/etiology , Reoperation , ThumbABSTRACT
BACKGROUND: To evaluate the effectiveness of the Robert view in assessing trapeziometacarpal arthrosis and to compare the accuracy of the Robert and lateral views in staging trapeziometacarpal (TM) joint arthrosis. METHODS: Patient demographics were obtained. Four participating raters reviewed 62 randomly selected thumb x-rays of patients presenting with thumb TM joint pain. Lateral and Robert-hyperpronation views were assessed using an analysis of 13 criteria. RESULTS: X-rays of 62 thumbs for 58 patients were evaluated. The average patients' age was 64 (47-87) and 51 (80%) were females. The majority of X-rays evaluated fell into stage 3. Stage 2 was the second most common level of arthritis encountered and the least was stage 1. More osteophytes were encountered in the trapezium than metacarpal on both the Robert and lateral views. The Robert view was superior in detecting osteophytes on the trapezium than the lateral view. Osteophyte size varied from 1.7 to 2 mm. The lateral view displayed 61 cases with dorsal metacarpal subluxation (98%). The Robert view displayed 48 cases (77%) with radial metacarpal subluxation and 9 cases (15%) with ulnar metacarpal subluxation. Thumb metacarpal adduction deformity was encountered on the lateral view in 20 cases (32%) whereas on the Robert view it was encountered in 14 cases (23%). Subchondral sclerosis was encountered on the Robert view in 56 thumbs (90%) while it was seen on the lateral view in 52 thumbs (84%). Pantrapezial arthritis involving the STT joint was encountered equally in 16 cases (26%) on the Robert view and the lateral views. The study found a moderate level of interrater reliability on both the lateral and Robert views. With the exception of osteophytes encountered on the trapezium versus the metacarpal, there were no other statistically significant findings. CONCLUSIONS: This study confirms that each of the Robert and lateral views offer unique information and combining both views enhances the ability to assess radiographic disease severity, and should be the recommended set of X-rays for assessing TM osteoarthrosis.